Optimal timing of wound drain removal following total joint arthroplasty

Drinkwater, Christopher; Neil, Michael J.

doi:10.1016/s0883-5403(05)80125-1

Cited by 168 publications

(105 citation statements)

References 13 publications

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“…First, our criterion for drain removal was drainage less than 100 ml in 24 h, since we felt that at a rate below this the probable risk of wound infection due to bacterial migration along the drain with time outweighed the risk of developing a wound haematoma [17]. These migrating bacteria, the numbers of which are bound to increase with longer duration of drainage, might give false-positive suction tip cultures before they actually infect the wound [7,17]. Following the above-mentioned criterion, we could remove all the drains within 48 h. Second, we disinfected the skin surrounding the drain before removing it.…”

Section: Discussionmentioning

confidence: 99%

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Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations

Sankar

Ray

Rai

2004

International Orthopaedics (SICOT)

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We conducted a prospective cohort study in order to determine whether suction drain specimen cultures from orthopaedic surgery predicted an early wound infection. We included 218 consecutive clean orthopaedic operations requiring drains in one unit over a period of 1 year. The suction drain tip, drain fluid and wound discharge specimens were cultured, and the surgical wound was followed up for 3 months. There were six deep and two superficial wound infections. Wound infection was significantly related to positive suction tip culture but not to positive drain fluid culture. Following our methodology for culture, a positive drain tip culture predicts wound infection in 50% and a negative culture virtually excludes the possibility of a deep infection.Résumé Nous avons conduit prospectivement une étude de cohorte pour déterminer si les cultures d'un échantillon du produit de drainage aspiratif peuvent être prédictives précocément d'une infection. Nous avons inclus 218 opérations orthopédiques propres consécutives, exigeant un drainage, sur une période d'une année. L'extrémité du drain, le liquide de drainage, et des prélévements opératoires étaient mis en culture et la cicatrice chirurgicale surveillée pendant 3 mois. Il y avaient 2 infections superficielles et 6 pronfondes. L'infection était en rapport significatif avec la culture du drain mais sans rapport avec celle du liquide de drainage. En suivant notre méthodo-logie, une culture positive de l'extrémité du drain prédit l'infection de la blessure dans 50% et une culture négative exclut la possibilité d'une infection profonde.

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Section: Discussionmentioning

confidence: 99%

“…Most of these infections are thought to originate from bacterial wound contamination at the time of operation, the incidence of which has been reported to be as high as 58% [7]. The majority of these bacteria are removed by local wound defence mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations

Sankar

Ray

Rai

2004

International Orthopaedics (SICOT)

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“…This practice is based on more than hearsay; we have been able to find at least one instance of a published recommendation to ''use prophylactic antibiotics at least until drain removal'' [36]. The major evidence for this assertion seems to derive from several bacteriologic and animal studies [23,76,103].…”

Section: Antibiotics For Wound Drainage and Drainsmentioning

confidence: 99%

Myths and Legends in Orthopaedic Practice: Are We All Guilty?

Tejwani

Immerman

2008

Clinical Orthopaedics &Amp; Related Research

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Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices.

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“…if the drainage tube remains in situ more than 24 h,'' which is refuted objectively by the statistical result (w 2 = 0.825, 0.10 > p > 0.05) [73]. To confirm the findings of Willett et al [73], Drinkwater et al [6] performed a prospective study at two institutions of 92 patients undergoing total hip or knee arthroplasty with CSD placement. Antibiotic and VTE prophylaxis was standardized.…”

mentioning

confidence: 97%

“…As stated by Dougherty and Simmons in their extensive 1992 review of drainage tactics, drains serve to ''prevent or evacuate accumulations of fluid or gas'' [5]. Drains are placed commonly in the operative setting to prevent abscess or hematoma formation and are hypothesized to lead to surgical site infection (SSI) via external or luminal contamination and subsequent inward (retrograde) bacterial migration along the drain surface [6][7][8]. In contrast to passive (open) drains, closed-suction drains (CSDs) establish a pressure gradient between the wound and the external environment and empty into a sealed reservoir, and are believed to reduce the ''risk of retrograde microbial contamination'' [5].…”

mentioning

confidence: 99%

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

Reiffel

Barie

Spector

2013

Surgical Infections

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Background: Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. Methods: The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. Results: Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine postoperative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. Conclusions: Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to ''cover'' an indwelling drain.

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Optimal timing of wound drain removal following total joint arthroplasty

Cited by 168 publications

References 13 publications

Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations

Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations

Myths and Legends in Orthopaedic Practice: Are We All Guilty?

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

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